Flesh-Eating Drug 'Krokodil' Hits The U.S.

A flesh-eating narcotic known as “krokodil” has made its landing in the United States. The drug is injected, leaving the skin with gangrenous wounds and scaly, green flesh — hence the name “crocodile.”

The narcotic, usually created by mixing codeine with household ingredients like gasoline and iodine, emerged in Russia more than 10 years ago during a heroin shortage. Recent cases in the United States have been identified in Arizona, Illinois and Utah.

Toxicologists around the country are starting to worry about a new drug that has reportedly sent people to the hospital in Arizona and Illinois. It is a flesh-eating narcotic known as Krokodil. It reportedly originated in Russia years ago during a heroin shortage. Amber Neitzel is one of five cases reported in Illinois. She described her skin lesions to a local ABC TV affiliate.

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AMBER NEITZEL: It almost starts out like I got burned with a cigarette. It's like purple, and then it goes, like, into a blister.

HOBSON: Her sister, Angie Neitzel, also a user, has such a severe case that she required emergency surgery.

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ANGIE NEITZEL: I have to go see the infectious disease doctor in two weeks, and we're going to just - in two weeks, we're going to decide how far it's progressed. And they're going to wind up doing skin grafting, in the end.

HOBSON: Dr. Frank LoVecchio says he's seen a handful of cases in Arizona, but they haven't been confirmed by the U.S. Drug Enforcement Agency. Dr. LoVecchio is co-medical director at Banner Good Samaritan Poison and Drug Information Center. He's with us from KJZZ in Phoenix to talk about Krokodil. Dr. LoVecchio, welcome.

FRANK LOVECCHIO: Thanks for having me, Jeremy.

HOBSON: And what is it, exactly?

LOVECCHIO: It's a synthetic drug, and it's made by taking a drug like Codeine. Codeine is the most common drug that's used. And people like to take a drug that is commonly taken by mouth and take it and inject it. And by putting into the intravenous form or a form that you can inject it, they have to mix it with certain things. And those certain things, or the contaminants, are what's causing a problem.

HOBSON: And those things are stuff that you really would not want to be putting in your body. Turpentine, hydrochloric acid, things like that are going into Krokodil, right?

LOVECCHIO: That's right. Gasoline. Other things include red phosphorus, iodine. And even if a drug company tried to get all of those things out, there's always some impurities left behind. And we know from other examples that, you know, hydrochloric acid causes lots of damage to the skin, you know, gasoline, turpentine causes lots of damage to the skin. And we see that in some of our patients. And we've seen that in the experience that they've had in Russia and the Ukraine, where the average life in the people that have used this, once they started using it, is about one to two years.

HOBSON: Hmm. And what does it do to them? We've heard the reason that it's called Krokodil is because it makes your skin scaly.

LOVECCHIO: That's right. If you use it and you survive the initial insult, you know, typically going into your vein, and the vein becomes sclerotic, or the vein kind of dies. And also what happens is the fat cells also die. So you see a dimpling effect, or a scar that kind of looks like a bump. And your next move - I guess, if you survive that - is to look for another vein or another site. But what also happens is people get more and more necrosis or death of tissue around that site. And when they keep using it and using it, what happens is they get death of the tissue. And they can get - develop gangrene and loss of the extremity.

HOBSON: So why do people do it?

LOVECCHIO: Well, you know, we've been dealing with addiction, me personally, for about 20 years. At the Poison Center, it's a very difficult question to answer, but it's a very difficult disease. And the obvious question is: Why not just take the Codeine tablet? You have the Codeine tablet. And the answer most commonly given is that if you could take it and put it into the IV form, or intravenous form, you get a much quicker high, many times higher than you would normally get by taking it by mouth. You're happier quicker. Now, it does go away much sooner, but, you know, many people think they could just reshoot or, you know, redose themselves intravenously.

HOBSON: And it's a lot cheaper, right, than the more pure form?

LOVECCHIO: Yeah. Historically, in Russia, what happened is the heroin supply went down. And because they couldn't get heroin, they were using this. And, in Russia, we're told that it was available over the counter to buy Codeine, or Codeine-like products. In the United States, I've tried personally to look and see if I could buy Codeine or desomorphine over the counter or on the Internet, and there are sites that you could do that. Now, I have to say, honestly, I didn't press pay, because I know that it's illegal to buy via the Internet. But it is much cheaper than getting heroin. And if you do have the tablets at home, I think just a quick search on the Internet, you could probably find how to make it, and it's probably much safer than going to your local drug dealer.

HOBSON: Although some users are saying that they didn't even realize they were using Krokodil. Is it hard to figure out that that's what it is?

LOVECCHIO: That's very interesting because the users that say they didn't know what it was - I mean, it can be a white powdery substance or it can be given in a liquid form. And you probably would know after an injection or two because of the caustic substances associated with it or the toxic substances that often contaminate it. And what I mean by that, it would probably burn when you woke up from your high.

HOBSON: So what is it going to take to stop this before it really becomes a bigger problem in the United States?

LOVECCHIO: Well, I think getting the word out of the dangers of this. I think the big dangers between this and just, you know, simple heroin, which is probably not going to go away anytime soon, is the fact that it causes such bad skin problems. And I think once a user uses it once or twice, they're going to realize that, you know, this is a real problem.

If they get it by accident or they don't realize what they're buying, they have to realize that the same concentration of this versus the heroin is many times more potent in, you know, a volume basis, if that makes sense.

HOBSON: Put this in the broader context for us, Doctor, because this is coming just months after Cory Monteith died after using heroin and alcohol. That brought to light a big problem in this country, which is heroin use. Are you seeing more cases these days of people using these hard drugs and being addicted to them in dangerous ways?

LOVECCHIO: For the first time in our country, I mean, this is, you know, astonishing to me that accidental or death from prescription medications or drug use has surpassed car accidents or accidental death in that critical age of, like, 25 to 45. In other words, you are more likely to die of a drug overdose, whether it be intentional or accidental, than you are to get in a car accident.

HOBSON: Wow.

LOVECCHIO: And people don't realize this is the first time in our country's history that has occurred, you know, these last few years. You know, it's truly an epidemic.

HOBSON: And you can let us know your thoughts at hereandnow.org. We're also on Twitter: @hereandnow, @hereandnowrobin, @jeremyhobson. Let us know what you think. You're listening to HERE AND NOW. Transcript provided by NPR, Copyright NPR.